WHEN IT COMES to hospital-physician relations, both parties should concentrate on their similarities rather than their differences, industry experts say. By focusing on the goals and challenges they share instead of the divisive issues that drive them apart, hospitals and physicians can engage in constructive efforts to improve the healthcare system.
Provider groups are moving in the right direction and have the potential to form even stronger bonds in the future, said Erica Drazen, managing partner of emerging practices for Falls Church, Va.-based CSC Consulting.
“Relations are better than they have been in a long time. They are closer, tighter – however you want to describe it,” she said. “Because they have both been fighting declining (Medicare) reimbursement, they have the same adversary.”
Hospitals and physicians have always had a tenuous relationship. As separate provider entities, they sometimes compete for the same patients in outpatient surgery, rehabilitation, diagnostics and other services. As hospital team members, sparring is commonplace between management and employees over any number of issues, from compensation to administrative policies to OR scheduling.
Yet industry-wide initiatives like electronic health records and pay-for-performance have forced both sides to see each other as “allies in care” rather than business competitors, Drazen said.
“P4P is making them realize the collaboration between ambulatory and hospital care’s importance,” she said. “Hospitals have to engage physicians more because they need to come up with protocols for better care. Hospitals realize how dependent they are on physicians and physicians realize that the community hospital is their workplace.”
IT the catalyst
Although reimbursement pressures and shared hassles with payers have placed hospitals and physicians into the same ideological camp, the physical unifier is information technology infrastructure. Being able to share data between organizations is the goal of the EHR, P4P and regional health information organization initiatives, and having automated systems in place is the vehicle that will drive relationships forward in the future, Drazen said.
“IT has the potential to be a huge benefit to the relationship because of the new requirements,” she said. “The physician has always had access to hospital data, but when the hospital looks for data from the physician, there hasn’t been too much automation.”
Walter Zywiak, principal researcher for CSC’s emerging practices group, says IT adoption progress is being made at the physician practice level, but overall, the ambulatory care sector needs to start building an interactive automation system in earnest, especially with regard to electronic health records.
“Information systems are actually in pretty good shape in the physician domain with billing systems, but they are way behind in clinical systems and EHRs,” he said. “Larger practices (generally defined as 25 physicians and up) have a pretty decent penetration rate, but smaller ones really need to get going.”
EHR endgame
Ultimately, the electronic health record will follow the patient throughout the healthcare continuum, traveling from primary physician to the hospital through post-treatment, giving providers and payers that patient’s vital personal, clinical and financial data.
“The endgame objective is to view the patient’s full continuum, from the primary care to specialist, knowing that the patient is allergic to penicillin, the tests that have been done – you want all of those physicians to view it collectively,” said Michele Mann, partner with CSC’s global healthcare sector. “That is the goal. That would be the purest way of doing it, but not the easiest. Not everyone has the same system, so there needs to be a level of integration.”
But because physician practices – especially the small ones – face stiff cost and cultural challenges with adopting the technology, they often consider it a step beyond their reach. Some hospitals are underwriting the systems for physicians to jumpstart the process.
Once local acute and ambulatory care entities are connected, it can spread to other communities from there.
“Let’s get the backyard working before the whole state,” Mann said. “About 90 percent of patients see physicians in hospitals within 20 miles of their homes.”
At this point, though, Zywiak says there’s “no silver bullet” to trigger widespread physician participation.
“Somehow, physicians have to be convinced to go ahead and adopt the systems and then go through the trouble of connecting with hospitals,” he said. “I think it will eventually happen, but I’ve been saying that for quite a few years now.”